- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.81 / $371.47 / $893.62
| Facility | | $261.81 | $371.47 | $893.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.41 / $200.45 / $335.53
| Professional | | $159.41 | $200.45 | $335.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.26 / $327.51 / $703.64
| Facility | | $206.26 | $327.51 | $703.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.83 / $157.83 / $297.01
| Professional | | $157.83 | $157.83 | $297.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.32 / $165.25 / $333.41
| Facility | | $59.32 | $165.25 | $333.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.00 / $921.00 / $921.00
| Professional | | $921.00 | $921.00 | $921.00 |